8:15 a.m. - 3 Mile Power Walk 8:20 a.m. - 1 Mile Fun Walk |
| Pre-registration: (ends 8/6/2021) |
$14 for 5k $10 for Power Walk or Fun Mile | | Regular | Registration: |
$15 for 5K $11 for Power Walk or Fun Mile | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: Appalachia Railroad Days 5K | ||||
| Mail this form to: Box 302 Appalachia, VA 24216 | ||||
| Dorr prizes will be refund of 5 entry fees. Shirts guaranteed to all particpants |
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Randy Blair 1-276-455-9621 or 1-276-565-0406 | Appalachia Railroad Days 5K Male & Female Awards: Top Overall Top Masters Top GrandMasters Age Groups (top 3) ...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65... | 3 Mile Power Walk Male & Female Awards: Top Overall ...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65... |
| LAST NAME__________________________________ FIRST NAME_________________________ M.I._______ |
SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________ |
ADDRESS___________________________________________________________________________ |
CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________ |
RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________ |
*** CIRCLE EVENT: Appalachia Railroad Days 5K | 3 Mile Power Walk |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, XXL |
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IN CONSIDERATION FOR ACCEPTING MY ENTRY IN THIS RACE, I FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN SAID RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |